The Impact Of Glucose Fluctuation On Coronary Artery Disease Severity In Type 2 DM

Objectives:This study was aimed to explore the difference of glucose situation between the normalsubjects and DM patients through continuous glucose monitoring; The article was designed toexplore the impact of chronic blood glucose fluctuations on development of coronary arterydisease in patients with type 2 DM through the study of different glucose fluctuations betweenType 2 DM with and without cardiovascular complications.Methods:According to coronary angiography results, 37 patients were divided into 2 groups: withoutcardiovascular complications (group B ,n=14) and with cardiovascular complications (GroupC ,n=23). The scores according to SYNTAX scoring system were collected in group C. Inaddition, 10 cases were set as normal control group (Group A). General clinical date wascollected and continuous glucose monitoring system (CGMS)for 72h was applied on all thesubjects. The indexes reflecting the glycemic control were calculated such as mean bloodglucose（MBG）、glucose standard deviation（SD）、the largest amplitude of glycemic excursions（LAGE），the average amplitude of glycemic excursions（MAGE）、the number of effectiveblood glucose excursion（sNEGE）、postprandial glucose excursions of 3 dinner（sPPGE1 PPGE2PPGE3）.Glycemic excursions were compared between group A and group B and C, so did theybetween group B and group C. The key factors impacting on SYNTAX scores were analyzed ingroup C by multiple linear regression analysis. In addition, one day was divided into 8 sections,which were 0:00-3:00, 3:00-6:00, 6:00-8:00, 8:00-11:00, 11:00-13:00, 13:00-17:00, 17:00-19:00,19:00-24:00. The correlations with SYNTAX scores were analyzed in every section.Results:1.The group B and C had greater systolic blood pressure, glycated hemoglobin (HbA1c),Low Density Lipoprotein Cholesterol (LDL-c), MAGE, MBG, SD, LAGE, PPGE1, PPGE2,PPGE3, carotid intima-media thickness (IMT), C-reactive protein (CRP), insulin resistance index(HOMA-IR) than that in the group A, had fewer NEGE than that in the group A. The differencesall had statistically significant (P <0.05).2. HbA1c and MAGE, SD, IMT, CRP showed a increasing trend in the A,B,C three groups,in which the differences had statistically significant (P <0.05). The differences of age, diastolic blood pressure, PPGE3, HOMAβcell function index (HBCI) had statistically significantbetween group B and group C (P <0.05).3.The SYNTAX scores is related with systolic blood pressure and CRP, MAGE, HbA1c ingroup C, which had statistically significant with P <0.01 of systolic blood pressure and P <0.05of the rest . Multiple linear regression analysis was done with SYNTAX scores as dependentvariable and systolic blood pressure, CRP, MAGE, HbA1c as independent variables. Systolicblood pressure, CRP and MAGE entered the final equation.4. One day was divided into eight sessions. Significant correlations were found in 6-8 (P<0.01) and 11-13 (P <0.05) with the SYNTAX scores in group C.5.MAGE was positively correlated with age, CRP, HbA1c, HOMA-IR, IMT, SD, MBG,LAGE, postprandial glucose excursions of 3 dinners (P <0.01), was negatively correlated withHBCI (P <0.05), NEGE( P <0.01) in group B and C.Conclusions:1. Compared with normal subjects, T2DM patients have greater blood glucose fluctuationsand average blood glucose, fewer numbers of effective blood sugar fluctuations;2. T2DM patients with coronary artery disease may have larger glucose fluctuations thanthat in T2DM without coronary artery disease.3. Compared with high glucose, blood glucose fluctuations probably be more influential tothe development of coronary artery disease in patients with T2DM;4.Blood glucose fluctuations is related with carotid artery intima-media thicknesssignificantly in T2DM.